Obesity paradox on the survival of elderly patients with diabetes: an AHAP-based study

  • Ali Bijani
  • Robert G. Cumming
  • Seyed-Reza Hosseini
  • Masoumeh Yazdanpour
  • Mahdis Rahimi
  • Abbas Sahebian
  • Reza Ghadimi
Research Article


Background and objectives

Overweight and obesity are among the important challenges in health issues and survival of elderly people. The current study aimed to evaluate the survival rate of elderly patients with diabetes, and its influencing factors, on the basis of body mass index (BMI).

Methods and materials

The design of the current study was based on the Amirkola Health and Aging Project (AHAP) cohort. The 5–year survival rate of elderly people with diabetes and the factors that influence the mortality rate by Cox regression model were analyzed.


Out of 1616 elderly people who were evaluated in the current study, 501 (31%) had diabetes. The results showed that diabetes significantly increased the mortality rate (adjusted hazard ratio [HR] = 2.10; 95% confidence interval [CI]: 1.57–2.81; P < 0.001). Furthermore, overweight (HR = 0.41; 95%CI: 0.24–0.75; P = 0.002), obesity (HR = 0.30; 95% CI: 0.41–0.63; P = 0.002), history of diabetes (HR = 0.56; 95%CI: 0.34–0.93; P = 0.024), moderate and high physical activity level (HR = 0.36; 95%CI: 0.13–0.99; P = 0.049) decreased the risk of mortality and central obesity (HR = 1.76; 95% CI: 1.01–3.11; P = 0.049), fasting blood sugar ≥200 (HR = 2.46; 95% CI: 1.46–4.15; P < 0.001), brain stroke, and neurological diseases (HR = 3.12; 95% CI: 1.78–5.49; P < 0.001) increased the risk of mortality.


Although overweight and obesity significantly improved the risk of mortality in elderly patients with diabetes, central obesity is still considered as an important risk factor.


Obesity Survival Diabetes mellitus Aging 



amirkola health and ageing project


body mass index


confidence interval


cox proportional hazard


cerebrovascular accident


diabetes mellitus


duke social support index


fasting blood sugar


geriatric depression scale


international diabetes federation


physical activity scale for elderly


waist circumference



The authors would like to thank all authorities of Babol University of Medical Sciences,

AHAP collaboration and the elderly participants of this project.

Author contributions

AB, SRH, RC and RG conceived and designed the study. AB, MY, RR and AS gathered the data. AB performed the statistical analysis. AB drafted the manuscript. SRH and RG critically revised the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Our study was reviewed and approved by ethics committee, Babol University of Medical Sciences.


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Ali Bijani
    • 1
  • Robert G. Cumming
    • 2
  • Seyed-Reza Hosseini
    • 1
  • Masoumeh Yazdanpour
    • 3
  • Mahdis Rahimi
    • 3
  • Abbas Sahebian
    • 3
  • Reza Ghadimi
    • 1
  1. 1.Social Determinants of Health Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
  2. 2.School of Public HealthUniversity of SydneySydneyAustralia
  3. 3.Health Research InstituteBabol University of Medical SciencesBabolIran

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